Your child and the flu

Information

WHAT ARE THE SYMPTOMS I SHOULD WATCH FOR IN MY CHILD?

The flu is an infection of the nose, throat, and (sometimes) lungs. Your young child with the flu will usually have a fever of 100 °F or higher and a sore throat or a cough. Other symptoms you may notice:

• Chills, sore muscles, and headache
• Runny nose
• Acting tired and cranky much of the time
• Diarrhea and vomiting

When your child's fever goes down, many of these symptoms should get better.

HOW SHOULD I TREAT MY CHILD'S FEVER?

Do NOT bundle up a child with blankets or extra clothes, even if your child has the chills. This may keep their fever from coming down, or make it higher.

• Try one layer of lightweight clothing, and one lightweight blanket for sleep.
• The room should be comfortable, not too hot or too cool. If the room is hot or stuffy, a fan may help.

Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever in children. Sometimes doctors advise you to use both types of medicine.

• Know how much your child weighs, and then always check the instructions on the package.
• Give acetaminophen every 4 - 6 hours.
• Give ibuprofen every 6 - 8 hours. Do NOT use ibuprofen in children younger than 6 months old.
• NEVER give aspirin to children unless your child's doctor tells you to use it.

A fever does not need to come all the way down to normal. Most children will feel better when the temperature drops by even 1 degree. A lukewarm bath or sponge bath may help cool a fever.

• It works better if the child also is given medicine -- otherwise the temperature might bounce right back up.
• Do NOT use cold baths, ice, or alcohol rubs. These often make the situation worse by causing shivering.

WHAT ABOUT FEEDING MY CHILD WHEN HE OR SHE IS SICK?

Your child can eat foods while having a fever, but do not force the child to eat. Fluids should be encouraged to prevent dehydration.

Children with the flu usually tolerate bland foods better. A bland diet is made up of foods that are soft, not very spicy, and low in fiber. You may try:

• Breads, crackers, and pasta made with refined white flour
• Refined hot cereals, such as oatmeal and cream of wheat
• Do not give your child too much fruit or apple juice. Dilute these drinks by making them one half water and one half juice.
• Popsicles or gelatin (Jell-O) are good choices, especially if the child is vomiting.

WILL MY CHILD NEED ANTIVIRALS OR OTHER MEDICATIONS?

Children aged 2 years to 4 years without high risk conditions and with mild illness may not need antiviral treatment. Children 5 years and older will generally not receive antivirals unless they have another high-risk condition.

When needed, these medicines work best if started as soon as possible after symptoms begin, preferably within 48 hours.

Either oseltamivir (Tamiflu) or zanamivir (Relenza) are used.

• Oseltamivir comes as a capsule or in a liquid.
• Zanamivir is taken by inhaler.

Serious side effects from these medications are quite rare. Doctors and parents must balance the risk for rare side effects against the risk that their children can become quite sick and even die from the flu.

Talk to your doctor before giving any over-the-counter cold medicines to your child.

WHEN SHOULD MY CHILD SEE A DOCTOR OR VISIT AN EMERGENCY ROOM?

Talk to your child's doctor or go to the emergency room if:

• Your child does not act alert or more comfortable when their fever goes down.
• Fever and flu symptoms come back after they had gone away.
• There are no tears when they're crying.

SHOULD MY CHILD GET VACCINATED AGAINST THE FLU?

Even if your child has had a flu-like illness, they should still get the flu vaccine. If enough flu vaccine is available, all children 6 months or older should receive the vaccine. Children under 9 years will need a second flu vaccine around 4 weeks after receiving the vaccine for the first time.

There are two types of flu vaccine. One is given as a shot, and the other is sprayed into your child's nose.

• The flu shot contains killed (inactive) viruses. It is not possible to get the flu from this type of vaccine. The flu shot is approved for people age 6 months and older.
• A nasal spray-type swine flu vaccine uses a live, weakened virus instead of a dead one like the flu shot. It is approved for healthy children over 2 years. It should not be used in children who have repeated wheezing episodes, asthma, or other chronic respiratory diseases.

WHAT ARE THE SIDE EFFECTS OF THE VACCINE?

It is not possible to get the flu from either the injection or shot flu vaccine. However, some people do get a low-grade fever for a day or two after the shot. The flu shot is approved for people age 6 months and older.

Most people have no side effects from the flu shot. Some people have soreness at the injection site or minor aches and low-grade fever for several days.

Normal side effects of the nasal flu vaccine include fever, headache, runny nose, vomiting, and some wheezing. Although these symptoms sound like symptoms of the flu, the side effects do not become a severe or life-threatening flu infection.

WILL THE VACCINE HARM MY CHILD?

A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite concerns, thimerosal-containing vaccines have NOT been shown to cause autism, ADHD, or any other medical problems.

Nevertheless, if you have concerns about mercury, all of the routine vaccines are also available without added thimerosal.

WHAT ELSE CAN I DO TO PROTECT MY CHILD FROM THE FLU?

Everyone who comes in to close contact with your child should follow these tips:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after using it.
• Wash hands often with soap and water for 15 - 20 seconds, especially after you cough or sneeze. You may also use alcohol-based hand cleaners.
• Wear a facemask if you have had flu symptoms, or preferably stay away from children.

If your child is less than 5 years old and has close contact with someone with flu symptoms, talk with your doctor or nurse.

References

Fiore AE, Fry A, Shay D, et al; Centers for Disease Control and Prevention (CDC). Antiviral agents for the treatment and chemoprophylaxis of influenza --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011 Jan 21;60(1):1-24.

Update Date: 9/7/2011

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.